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32

NCCN Guidelines for Patients

®

Peripheral T-cell Lymphoma, Version 1.2016

3

Overview of cancer treatments Stem cell transplant

Stem cell transplant

Hematopoietic stem cells are cells that develop

into mature blood cells. Hematopoietic stem cells

and mature blood cells are made in bone marrow.

Cancer or its treatment can damage or destroy the

cells in bone marrow. A stem cell transplant replaces

damaged or destroyed stem cells with healthy stem

cells, which form new marrow and blood cells. There

are two types of stem cell transplant.

Autologous stem cell transplant uses your healthy

stem cells to repair bone marrow. This treatment

is also called HDT/ASCR (

h

igh-

d

ose

t

herapy with

a

utologous

s

tem

c

ell

r

escue). Healthy stem cells will

be collected from you when imaging tests show that

cancer treatment is working. You will then receive

intense chemotherapy and maybe radiation to destroy

any remaining cancer cells. This intense treatment

will also destroy bone marrow, so your healthy stem

cells will be put back into your body to “rescue” your

marrow.

Allogeneic stem cell transplant uses healthy stem

cells that come from a donor. HLA (

h

uman

l

eukocyte

a

ntigens) typing is the test used to check if the donor

and your tissue type are a good fit. Chemotherapy will

be given to destroy cancer cells and suppress your

immune system from attacking the donor cells. The

transplanted stem cells will form new marrow and

attack remaining cancer cells. This attack is known

as the GVT (

g

raft-

v

ersus-

t

umor) effect. On the other

hand, there is a serious risk of GVHD (

g

raft-

v

ersus-

h

ost

d

isease). GVHD is when the donated cells see

the cells in your body as foreign and attack them.

A stem cell transplant is not an option for every

person with peripheral T-cell lymphoma. A stem

cell transplant can have severe side effects so it is

not given to people who are frail or quite sick. An

autologous transplant may be given only when prior

drug treatment appears to have worked. An allogeneic

transplant may be an option after a second course

of drug treatment. Autologous stem cell transplant is

more commonly used for peripheral T-cell lymphoma.

More details on this transplant are given next.

Collecting your stem cells

The first step of an autologous stem cell transplant

is to collect, or harvest, the blood stem cells. Blood

stem cells are found in the bone marrow and in the

bloodstream. If stem cells are collected from blood, a

process called apheresis will be done. First, medicine

is sometimes given to increase the number of stem

cells in blood. Then, some blood will be removed from

a large vein most likely in your arm. The blood will

flow through a tube and into a machine that removes

stem cells. The rest of the blood will be returned

through the other arm.

Apheresis typically takes 4 to 6 hours and does not

require anesthesia. It may take two or more sessions

to obtain enough stem cells. During the procedure,

you may have lightheadedness, chills, numbness

around the lips, and cramping in the hands.

Bone marrow aspiration is used to remove bone

marrow. For this procedure, either regional anesthesia

or general anesthesia will be given. Next, a needle

will be inserted through the skin into the hip bone

to draw out the bone marrow. The needle must be

inserted many times into one or more spots to collect

enough marrow. The marrow will then be processed

to collect the stem cells.

Collection of the bone marrow takes about 1 hour.

The entire hospital stay will likely be 6 to 8 hours,

which includes recovery time. The aspiration will

likely cause some pain and soreness for a few days.

Anesthesia may cause nausea, headache, and

tiredness.

After apheresis or aspiration, the harvested cells

will be combined with a preservative. Then, they will